The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.

Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.

CBS Evening News ran a very informative piece by Katie Couric this week on the distressing proliferation of so-called “superbugs,” infections that contain genetic mutations which make them resistant to antibiotics. By being able to “outsmart the pills,” as Ms. Couric put it, something as relatively commonplace as a urinary tract infection can lead to serious health consequences and lengthy hospital stays.

The pharmaceutical industry is racing to catch up with the threats posed by these superbugs. Dr. John Rex, who heads drug development for AstraZeneca (a Healthcare Leadership Council member) was interviewed for the CBS story and discussed the complex challenges in creating a medication that “kills the bacteria but doesn’t hurt you and me.”

The story also provides a better understanding of the level of investment needed to bring critical new drugs to market. As Ms. Couric reported, remedies like those being developed to combat these genetically-mutated infections require a decade and roughly $1.7 billion to bring the drug from the laboratory to the local pharmacy.

I’m not going to wade into partisan politics here because the Healthcare Leadership Council has a long-standing policy against endorsing political candidates. I am concerned, though, about the “repeal and replace” message, relating to health reform, that a number of candidates are using as a focal point for their campaigns.

First, we can say with virtual certainty that repeal of the Affordable Care Act isn’t going to happen. Not only does the President still have veto power, but it is also highly unlikely that repeal legislation could muster 60 votes to get through the U.S. Senate.

But beyond the political realities, there’s also a question as to whether it’s an effective message or even the right thing to do.

Bill McInturff of Public Opinion Strategies, one of the nation’s premiere experts when it comes to collecting and analyzing public opinion, made some excellent points on this subject in an interview with Marilyn Werber Serafini that appeared in both The Washington Post and Kaiser Health News. McInturff argues that it’s not logical to insist that all facets of the new health reform law is bad.

He said, “If you’re for repeal and replace, it means you have to say that every single element of health care is something you disagree with, or at least allows your opponent to characterize your position that way. That seems to me to not make much sense. Number two, people are conscious that we fought for a year about this. And so telling people that we’re going to start totally from scratch and do it again, there’s a certain kind of weariness about the process.”

Even if repeal of health reform was a feasible possibility, would Americans really want to roll back assistance for small businesses to help provide private health coverage for their employees, or new measures to help more people get preventive care and reduce the chronic disease costs that drive health spending skyward?

The fact is that health reform does need to be revisited. The measure passed by Congress, among other flaws, isn’t strong enough in its delivery reform and payment reform aspects and relies too heavily on the Medicaid program to reduce the uninsured rolls. But we don’t want to throw out the important progress that has already been achieved and, as McInturff assets, it’s not a particularly effective message to say that we should.

Everyone loves the underdog-finds-success type of story. And that’s exactly what the Medicare Part D program has become. Born out of political conflict and controversy and facing no shortage of experts that predicted its demise, new information shows that the Medicare prescription drug benefit remains highly popular.

Five years after the initial enrollment period, the Medicare Part D prescription drug program still continues to defy its doubters. At its outset, critics said health plans wouldn’t participate in Part D, but today seniors have ample choices of affordable plans. They said the program would cost too much, but the last Medicare trustees report reported costs are 41 percent below initial expectations. And they said seniors would find the program too confusing, but it remains enormously popular.

A survey of seniors nationwide, conducted in September by KRC Research and commissioned by Medicare Today, found that 84 percent feel favorably toward the Part D program. That’s actually up six points from the program’s popularity rating in 2006.

Additionally, the KRC Research survey found that 65 percent of beneficiaries feel no need to shop around for another plan while 31 percent said it is very likely they will compare their current plan’s costs and benefits with available alternatives. This finding clearly indicates to me that the majority of consumers are finding value in their current prescription drug plans.

Even with the high approval and value ratings, there is still work to be done. Only one in five seniors are aware that eligible beneficiaries who have drug spending that places them in the so-called “donut hole” will receive a 50 percent discount on brand-name prescription drugs beginning next year. Seniors on limited incomes need to plan their spending and budget their resources and it’s important they know about these changes. We also need aggressive outreach to locate those financially-challenged beneficiaries who aren’t enrolled in the program and could benefit from the Part D low-income subsidies.

The success, though, of the Part D program is underscored by the silence of its once-doubters and critics.

I want to thank the leaders and experts from various health sectors, academia, government agencies, Capitol Hill and patient advocacy groups who participated in this week’s Summit on Physician-Industry Collaboration.

I also want to acknowledge Susan Dentzer, editor-in-chief of Health Affairs, for her superb work in moderating the summit and the leadership of Lahey Clinic CEO Dr. David Barrett and Medtronic Chairman and CEO Bill Hawkins in co-chairing the event.

Over the course of the day Monday, we had important discussions and a frank exchange of view on the various issue affecting the collaborative work of physicians and the healthcare industry in developing new medical innovations for patient care. Several individuals noted what an important stride it was to bring so many sectors to the same table to share perspectives.

At the end of the day, I believe some common ground was found on a number of points:

• Collaboration between health professionals and industry is essential in moving products to the marketplace more rapidly and ensuring that they are safe and effective for patients.

• Industry sectors, individual companies and professional societies have made strides in developing standards to ensure principled collaboration, but there is not a central inventory to collect these standards and determine where they may conflict or overlap.

• There is still cynicism within the public and within governmental agencies and Capitol Hill regarding collaborative agreements and work needs to be done to establish trust and public confidence.

We didn’t expect to come to firm conclusions or sustainable solutions in a one-day summit, but we did begin to understand the steps that need to be taken to establish consensus on this issue, beginning with developing a common understanding of the standards governing collaboration that already do exist and the ways in which collaboration benefits patients and consumers. This work will continue.

This Summit was part of the National Dialogue for Healthcare Innovation, an initiative of the Healthcare Leadership Council to bring together diverse voices focusing on issues affecting the future of American medical innovation. More summits are planned for 2011.

Some very different perspectives are being brought to the table as government officials and private health insurers provide their views on the physician-industry collaboration issue.

Private payers are drawing a line between collaboration that should be rewarded and that which shouldn’t, the former being collaboration that delivers better health outcomes at better value. Executive branch officials and Capitol Hill staffers emphasized that both the public and government prosecutors have substantial skepticism about collaborative agreement, but also acknowledged that the healthcare industry has done a great deal of work to elevate standards and establish strong principles.

Health industry innovators responded that it would be counterproductive to focus strictly on cost in determining the value of innovation and collaboration, that to look at cost without factoring in the long-term benefit to patients will strangle innovation.

Look for more in this space with a summary of the Summit on Physician-Industry Collaboration.